Dissection Management with Drug-Coated Balloons

  • Gaetano Di Palma
  • Bernardo Cortese


In the “pre-stent era,” the immediate and midterm outcome of percutaneous transluminal coronary angioplasty (PTCA) was severely affected by restenosis, abrupt vessel closure, and coronary dissection. Regardless of the angiographic and morphological classification {Waller:1992tr}, the incidence of coronary dissection after PTCA has been reported ranging from 4% to 45% {Dorros:1983wf}{GuiterasVal:1987wy}, while autoptic studies showed the presence of coronary dissections in up to 80% of the cases, independently from the cause of death {Baughman:1981gb}, of patients treated with balloon angioplasty.


  1. 1.
    Waller BF, Orr CM, Pinkerton CA, Van Tassel J, Peters T, Slack JD. Coronary balloon angioplasty dissections: “the good, the bad and the ugly”. J Am Coll Cardiol. 1992;20:701–6.CrossRefGoogle Scholar
  2. 2.
    Dorros G, Cowley MJ, Simpson J, Bentivoglio LG, Block PC, Bourassa M, Detre K, Gosselin AJ, Grüntzig AR, Kelsey SF, Kent KM, Mock MB, Mullin SM, Myler RK, Passamani ER, Stertzer SH, Williams DO. Percutaneous transluminal coronary angioplasty: report of complications from the National Heart, Lung, and Blood Institute PTCA Registry. Circulation. 1983;67:723–30.CrossRefGoogle Scholar
  3. 3.
    Guiteras Val P, Bourassa MG, David PR, Bonan R, Crépeau J, Dyrda I, Lespérance J. Restenosis after successful percutaneous transluminal coronary angioplasty: the Montreal Heart Institute experience. Am J Cardiol. 1987;60:50B–5B.PubMedGoogle Scholar
  4. 4.
    Baughman KL, Pasternak RC, Fallon JT, Block PC. Transluminal coronary angioplasty of postmortem human hearts. Am J Cardiol. 1981;48:1044–7.CrossRefGoogle Scholar
  5. 5.
    Cappelletti A, Margonato A, Rosano G, Mailhac A, Veglia F, Colombo A, Chierchia SL. Short- and long-term evolution of unstented nonocclusive coronary dissection after coronary angioplasty. J Am Coll Cardiol. 1999;34:1484–8.CrossRefGoogle Scholar
  6. 6.
    Albertal M, Van Langenhove G, Regar E, Kay IP, Foley D, Sianos G, Kozuma K, Beijsterveldt T, Carlier SG, Belardi JA, Boersma E, Sousa JE, de Bruyne B, Serruys PW, DEBATE II Study Group. Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting. Heart. 2001;86:193–8.CrossRefGoogle Scholar
  7. 7.
    Amin N, De Vito Dabbs A, Gilchrist IC. Serial angiographic appearance of healing dissection after balloon angioplasty. Cathet Cardiovasc Diagn. 1994;33:237–40.CrossRefGoogle Scholar
  8. 8.
    Tepe G, Zeller T, Schnorr B, Claussen CD, Beschorner U, Brechtel K, Scheller B, Speck U. High-grade, non-flow-limiting dissections do not negatively impact long-term outcome after paclitaxel-coated balloon angioplasty: an additional analysis from the THUNDER study. J Endovasc Ther. 2013;20:792–800.CrossRefGoogle Scholar
  9. 9.
    Agostoni P, Belkacemi A, Voskuil M, Nathoe HM, Doevendans PA, Stella PR. Serial morphological and functional assessment of drug-eluting balloon for in-stent restenotic lesions: mechanisms of action evaluated with angiography, optical coherence tomography, and fractional flow reserve. JACC Cardiovasc Interv. 2013;6:569–76.CrossRefGoogle Scholar
  10. 10.
    Fukushima T, Ashikaga T, Yoshikawa S, Hatano Y, Ueshima D, Yamamoto T, Yasuhiro M, Isobe M. Effect of drug-coated balloon on stent restenosis, neointimal proliferation, and coronary dissection: an optical coherence tomography analysis. Coron Artery Dis. 2017;29:39–45.Google Scholar
  11. 11.
    Kleber FX, Schulz A, Waliszewski M, Hauschild T, Böhm M, Dietz U, Cremers B, Scheller B, Clever YP. Local paclitaxel induces late lumen enlargement in coronary arteries after balloon angioplasty. Clin Res Cardiol. 2015;104:217–25.CrossRefGoogle Scholar
  12. 12.
    Speck U, Cremers B, Kelsch B, Biedermann M, Clever YP, Schaffner S, Mahnkopf D, Hanisch U, Böhm M, Scheller B. Do pharmacokinetics explain persistent restenosis inhibition by a single dose of paclitaxel? Circ Cardiovasc Interv. 2012;5:392–400.CrossRefGoogle Scholar
  13. 13.
    Aoki J, Colombo A, Dudek D, Banning AP, Drzewiecki J, Zmudka K, Schiele F, Russell ME, Koglin J, Serruys PW, TAXUS II Study Group. Peristent remodeling and neointimal suppression 2 years after polymer-based, paclitaxel-eluting stent implantation: insights from serial intravascular ultrasound analysis in the TAXUS II study. Circulation. 2005;112:3876–83.CrossRefGoogle Scholar
  14. 14.
    Her AY, Ann SH, Singh GB, Kim YH, Okamura T, Garg S, Koo BK, Shin ES. Serial morphological changes of side-branch ostium after paclitaxel-coated balloon treatment of de novo coronary lesions of main vessels. Yonsei Med J. 2016;57:606–13.CrossRefGoogle Scholar
  15. 15.
    Nakazawa G, Finn AV, Vorpahl M, Ladich ER, Kolodgie FD, Virmani R. Coronary responses and differential mechanisms of late stent thrombosis attributed to first-generation sirolimus- and paclitaxel-eluting stents. J Am Coll Cardiol. 2011;57:390–8.CrossRefGoogle Scholar
  16. 16.
    Clever YP, Peters D, Calisse J, Bettink S, Berg M-C, Sperling C, Stoever M, Cremers B, Kelsch B, Böhm M, Speck U, Scheller B. Novel sirolimus-coated balloon catheter: in vivo evaluation in a porcine coronary model. Circ Cardiovasc Interv. 2016;e003543:9.Google Scholar
  17. 17.
    Piraino D, Buccheri D, Cortese B. Paclitaxel-coated balloon exerts late vessel healing and enlargement: a documented phenomenon with optical coherence tomography analysis. Int J Cardiol. 2016;203:551–2.CrossRefGoogle Scholar
  18. 18.
    Piraino D, Cortese B, Buccheri D, Dendramis G, Andolina G. Healing after coronary artery dissection: the effect of a drug coated balloon angioplasty in a bifurcation lesion. A lesson from intravascular ultrasound analysis. Int J Cardiol. 2016;203:298–300.CrossRefGoogle Scholar
  19. 19.
    Cortese B, Silva Orrego P, Agostoni P, Buccheri D, Piraino D, Andolina G, Seregni RG. Effect of drug-coated balloons in native coronary artery disease left with a dissection. JACC Cardiovasc Interv. 2015;8:2003–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gaetano Di Palma
    • 1
  • Bernardo Cortese
    • 1
  1. 1.Cardiac DepartmentSan Carlo ClinicMilanoItaly

Personalised recommendations